2018 Charge Conference Form - Annual Report Diaconal Minister_KENTUCKY EAST

Please note that all questions marked with an asterisk (*) are required fields.

If a required question does not pertain to you, or you do not have that information at the time you are filling out this form, please input "N/A" in the blank field. 

When you complete with the form, make sure to click 'Save Form'.  The form will not be submitted and be saved if you have left any required questions (those marked with an asterick) blank.  You may return at any time to make changes.

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Please list your mailing address below.

*First Name
*Last Name
*Address 1
*Address 2
*City
*State
*Email
Phone (office):

Please include area code.

Phone (residence):

Please include area code.

Phone (cell):

Please include area code.

Fax

Please include area code.

*Birthdate:

Please enter date as: MM/DD/YYY - example 07/01/2017

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*Present Position:
*You are a member of which Annual Conference?
*District
*Church Membership
*Have you changed positions during the last year?
Yes
No
Former Position

Please give name and address of former position and the date of change. 

Not currently employed?

Please list the place and the date of the last employment approved by the Conference Board of Ordained Ministry.

*Area of Certification, Commission, Specialization, or Field of Service
*Request for annual review and renewal of certification, commission, specialization has been sent to appropriate agency?
Yes
No
*Date of consecration to Office of Diaconal Minister

Please enter date as MM/DD/YYYY - example 07/01/2017

On Leave?
No answer
First Year
Second Year
Third Year
Fourth Year
Fifth Year

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*Reflection

Read ¶¶ 301 and 302 of the 2012 Book of Discipline, reflect, and write about the ways in which you have practiced servanthood in the church and world.

You may upload a document to answer this section instead of typing in the space below.  If you do choose to upload a document, just type "See Attachment" in the space below and upload your documents in the "Upload Files" section.

*Professional Growth

In what ways have you fulfilled your plans for professional growth during the past year, including spiritual enrichment, service, missional, and continuing education opportunities?

You may upload a document to answer this section instead of typing in the space below.  If you do choose to upload a document, just type "See Attachment" in the space below and upload your documents in the "Upload Files" section.

*Continuing Education

Describe your plans for continuing education for the upcoming year.

You may upload a document to answer this section instead of typing in the space below.  If you do choose to upload a document, just type "See Attachment" in the space below and upload your documents in the "Upload Files" section.

*Upload files:

You may upload any documents partaining to your Reflection, Professional Growth, and/or Continuing Education plans.

Attach the evaluation of your immediate supervisor regarding ways in which you have been faithful to your call. The supervisor, as deemed appropriate by the conference Board of Ordained Ministry, may be the senior pastor, pastor/staffparish relations committee, agency supervisor, district superintendent, or staff of the conference council on ministries.

Attach file pdf, doc(x), xls(x), jpg/gif/png, ppt - up to 25 MB

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Acknowledgment

By checking this box and entering my name below, I am electronically signing this form.

Enter your name.
Today's Date:

Annual reports for certification and diaconal ministry may be combined and used for the Charge Conference.

Send a copy to the registrar from your conference Board of Ordained Ministry responsible for diaconal ministers, and keep a copy for your personal records.

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When you complete this form, make sure to click 'Save Form'. You may return at any time to make changes.

 

Revised July 2018

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